Wage &
Workplace Standards Forms
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EMPLOYEE COMPLAINT FORMS /
Denúncia Formulários em Português
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Claim for Wages, Statement of
(complete on-line and print)
(PDF, 94KB)
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Required Commission statement addendum (WORD,
10KB)
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Claim for Wages, Statement of
(Fillable)(Spanish)
(PDF,
111KB)
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Claim for Wages, Statement of
(Printable) (Spanish)
(PDF,
111KB)
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Complaint Forms
Index
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Statement of Alleged
Violation of the CT Family and Medical Leave Act (WORD, 85KB)
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Workplace Standards Complaint Form
(WORD, 108KB)
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Workplace Standards
Complaint Form (Fillable)(Spanish)
(WORD, 127KB)
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Workplace Standards
Complaint Form (Printable)(Spanish)
(WORD, 127KB)
Denúncia Formulários em Português
Employer Authorization, Request
and Registration
Forms
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Other Employer Forms
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Certified Payroll Form WWS -
CPI
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Contracting Agency Certification Form (PDF,
80KB)
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Contracting Agency Original
Request for Prevailing Wage Rate Form
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Contractor’s Wage Certification Form (PDF, 373KB)
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Exempt/Non-Exempt
Status Worksheet for Managerial or Executive Employees (PDF, 270KB)
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Payroll Certification For Covered Service Worker Contracts (PDF, 270KB)
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Payroll Certification
For Covered Service Worker Contracts – For Food Service Contracts Only (PDF, 505KB)
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Payroll Certification
For Covered Service Worker Contracts (SAMPLE) (PDF, 155KB)
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Payroll Certification
For Public Works Projects (SAMPLE) (PDF, 101KB)
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Payroll Certification for Public Works Projects (PDF, 701KB)
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Prevailing Wage Rates
Request Form (PDF, 116KB)
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Private Employment
Agency Forms & Information
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Private Employment Agency New Registration Instructions (PDF)
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Professional
Employer Organizations
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Standard Wage Rate
Determination For Certain Service Workers (print and manually complete)
(PDF, 11KB)
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Standard Wage Rate
Determination For Certain Service Workers (complete and submit on-line)
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Tip Statement (PDF, 8KB)
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200 Folly Brook Boulevard, Wethersfield, CT 06109 / Phone: 860-263-6000
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State of Connecticut
Disclaimer and
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